High school football players increasingly are bigger, faster, stronger — better.

The level of medical care awaiting them on the sideline has not kept pace.

While professional and college football teams have physicians, athletic trainers and other specialists at their disposal, medical support is spotty at the high school level.

For those who think new state laws aimed at proper treatment of concussions and prevention of long-term brain injury are just a first step, improving medical support is high on the list of suggested next steps.

Usually, the best a high school football team can hope for is one full-time athletic trainer at games and practices, and maybe a physician at games.

Estimates vary of how many U.S. high schools have access to an athletic trainer. Jim Thornton, president of the National Athletic Trainers Association, puts that estimate at “a little over half.”

As head athletic trainer for NCAA Division II Clarion (Pa.) University, Thornton has himself, four other full-time athletic trainers and a student staff to take care of about 400 athletes.

“You go down to the local high school, and it’s one athletic trainer taking care of 400 athletes in six different venues,” Thornton said.

He cites budget constraints at high schools for the lack of athletic trainers.

A full-time athletic trainer in a high school typically will make around $40,000 per year.

Dr. Robert C. Cantu is a neurosurgery professor at the Boston University School of Medicine and medical director of the Sports Legacy Institute, an organization that strives to advance the study, treatment and prevention of brain trauma. He talked about the “uneven playing field” at the prep level. A well-funded private school might have multiple athletic trainers on staff while roughly half of the public schools across the country have none.

“That’s unfortunate, and certainly not where you’d like to see it,” Cantu said. “It’s a work in progress.”

Diagnosis of concussions is the job of a qualified physician. But from coaches to physicians, most people agree that when it comes to properly assessing and treating concussions and other head injuries during competition and practice, an athletic trainer is the most qualified and feasible option for high schools.

People become athletic trainers through accredited undergraduate or graduate programs, and must pass an exam for national certification. Athletic trainers focus on emergency care, injury prevention, clinical diagnosis, and therapy and rehabilitation for injuries. They generally work closely with physicians. More than 70 percent of certified athletic trainers hold at least a master’s degree.

“The modern athletic trainer is the gatekeeper between making a decision on concussion symptoms and proper referral of that student-athlete on the day and the moment it happens,” Thornton said.

Proper treatment relies on spotting concussion symptoms quickly and removing the athlete from play. The potential consequences of an athlete returning to play before a concussion heals include more severe concussions, long-term brain damage and death.

Page 2 of 2 - At those high schools without an athletic trainer, the responsibility for spotting concussion symptoms and pulling an athlete from play falls to coaches, officials, teammates and parents.